- Enrollment id
- O20040718000005
- Enrollment state
- NM
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1427033315
- Multiple npi flag
- N
- Ccn
- 327029
- Associate id
- 9234041708
- Organization name
- PRESBYTERIAN HEALTHCARE SERVICES
- Doing business as name
- TUCUMCARI HOME HEALTH
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 301 E MIEL DE LUNA
- City
- TUCUMCARI
- State
- NM
- Zip code
- 88401